The Puerto Rico health care delivery system has experienced dramatic changes over the last 20 years. Amid different reform proposals implemented in the past, critical health disparities exist which are intertwined with cost, access and quality issues regarding vulnerable populations. Puerto Ricans in the U.S. also exhibit the worst health status profile of all Latino subpopulation groups in the country. In order to assist decision-makers in evaluating health policy options, it is critical to develop research-based knowledge founded on the reality of the Puerto Rican and U.S. health care systems. Based on this primary need, this application proposes to maintain and further develop a sustainable health services research infrastructure, the Puerto Rico Health Services Research Institute (PRHSRI) at the University of Puerto Rico Graduate School of Public Health targeting the following specific aims that will be completed within a period of three years: 1) Maintain an administrative structure in the Department of Health Services Administration of the Puerto Rico School of Public Health at the University that will support and foster the development of health services research; 2) Continue a faculty development and mentoring program that will enhance the capabilities of both the Department of Health Services Administration (DHSA) and the School of Public Health (SPH) to undertake health services research; 3) Formulate and conduct pilot projects in health services research that will lead to more comprehensive applications for external funding; and 4) Provide methodological and technical support that will facilitate: a) the identification and advancement of potential research ideas; b) the development of further applications based on pilot project findings for further external funding; and c) the dissemination of research findings for policy development purposes in the island and in the United States. For this grant cycle, the Institute plans on broadening its scope of target populations by examining both children in relation both to obesity and to access to primary care, and adults in relation to complementary and alternative medicine (CAM), and to the quality of primary care. Research conducted in the island provides researchers the unique opportunity to minimize "confounding" variables for which account must be made in studies in the U.S. since, in the island, language, culture and other environmental factors are automatically controlled for Puerto Ricans as research subjects. The long-term objective of this application is to extend the short-term pilot projects into more comprehensive comparative studies comparing the health of Puerto Ricans in the island with the health of Puerto Ricans living in the U.S. [unreadable] [unreadable] [unreadable] [unreadable]